Clin Exp Nephrol. 2025 Jun 4. doi: 10.1007/s10157-025-02709-5. Online ahead of print.
ABSTRACT
BACKGROUND: Membranous lupus nephritis (MLN), a distinct subtype of lupus nephritis (LN), is generally associated with more favorable outcomes than proliferative LN (PLN). However, clinical data regarding pure MLN are limited. We investigated the prognosis of patients with pure MLN in Japan.
METHODS: We performed a sub-analysis of a previously reported nationwide retrospective cohort study of patients with LN in Japan. This study included patients who underwent renal biopsy between 2007 and 2012. Patients with pure MLN (Class V, n = 90) were compared to those with PLN (Class III/IV ± V, n = 362) over a median follow-up period of 5 years. The primary outcome was defined as a 50% increase in serum creatinine (S-Cr) levels.
RESULTS: The renal and patient outcomes of the pure MLN and PLN groups were as follows: A ≥ 50% increase in S-Cr occurred in 12.2 vs. 16.3% of patients. Doubling of S-Cr or progression to end-stage kidney disease (ESKD) occurred in 4.4 vs. 8.6%, ESKD alone in 2.2 vs. 3.0%, and all-cause mortality in 7.9 vs. 5.5%. After adjusting for age, sex, baseline renal function, proteinuria, and the use of mycophenolate mofetil or intravenous cyclophosphamide, no significant differences in renal outcomes were observed between groups (hazard ratio 0.564; 95% confidence interval 0.272-1.170; P = 0.124).
CONCLUSION: In this nationwide Japanese cohort, no statistically significant differences in renal outcomes were observed between pure MLN and PLN. Further research is needed to explore strategies to improve outcomes in pure MLN.
PMID:40465063 | DOI:10.1007/s10157-025-02709-5
